By Dr Mukhtar Datti Ahmad
Bola Ahmed Tinubu, GCFR
President of the Federal Republic of Nigeria
Your Excellency,
The health care sector in Nigeria is in crisis. The estimates of the percentage of healthcare workers that have left our public health institutions over the last two years range from 30-50%. Some have ended up in my department which I lead in a relatively rural part of England. They have brought great value to our service but are clearly a huge loss to Nigeria. Some entire departments have been depleted.
The key destinations are the Middle East and Europe. The main task facing the incoming administration in terms of healthcare is stemming this tide and potentially reversing it. We need to address the root causes behind this exodus. The primary cause is poor and inconsistent pay. We need to have a frank conversation about how much we are willing to pay our key workers. Not just healthcare workers but teachers, emergency workers and all public servants. We cannot hold people to account while they are unable to feed their families or send their children to school. As President Roosevelt once said, ‘you cannot expect an empty bag to stand upright.’
The second root cause is the dilapidated state of our hospitals and primary health facilities. Even our best-known tertiary institutions are in a severe state of disrepair. Patients must purchase even the most basic of consumables. If you require an operation for example in most of our public hospitals, you will be given a list of consumables to buy. Sometimes, you must rent the sterile instruments that will be used, buy your own oxygen.
In addition to this, you pay a significant fee for example the fee for a major operation in a tertiary hospital goes up to N200-300k. This does not include the cost of your bed stays, food, nursing care etc. Many of our well-off compatriots do not appreciate that healthcare in our public hospitals is not free. In effect our hospitals have become inadequate private hospitals where you pay for a relatively poor service.
Many healthcare workers leave because they cannot see a path to career progression and personal development. I for one did not leave this country that I care for dearly for financial reasons. I left a very plum job because I could not see a path forward to achieving my dream of becoming a world class surgeon working with cutting edge technology.
The third root cause in my view is the simmering crisis in the health sector particularly between doctors and other healthcare professionals. This has eroded professionalism and patients often suffer the consequences. We must set up a panel of experts to look at this situation and make recommendations for how it can be improved. One example is senior nurses being held back from Director level positions so that a nurse leader would never be ‘senior’ to a doctor. There must be respect for all professionals and hierarchical leadership needs to be toned down.
Now we turn to what I consider the most important task in the healthcare sector – attracting the teaming Nigerian Healthcare Diaspora to return home partially or fully. We have a Diaspora Commission packed full of people that have never lived in the diaspora! No wonder they have achieved so little.
Many of us in the diaspora are willing to return home in some guise but are put off by seeming lack of interest from the government at all levels. If we are serious about attracting the diaspora, we need to start with reorganizing the Diaspora Commission and through it provide a functional e-interface that allows those interested in contributing to register their interest.
The Diaspora Commission should act as a broker with the relevant government agencies to smoothen the process. I was embarrassed recently when two non-Nigerian colleagues who had come to teach were delayed at the airport for hours attempting to use pour dysfunctional Visa on Arrival process. The equipment that they brought worth thousands of dollars was impounded on flimsy grounds. They spent the following two days trying to secure the release of their baggage rather than training Nigerian healthcare professionals. At every stage, officials who are the first point of contact asked them ‘what did you bring for us?’ rather than say ‘welcome to Nigeria’.
The incoming government must look urgently at the funding mechanism for our tertiary health institutions. These are the apex teaching hospitals where culture and learning diffuse from. Currently, all income generated goes directly to the federation account. The institutions have no say in how the funds are spent. There is therefore no reward for improving income generation. The hospital leaders then waste a huge amount of time in Abuja, lobbying Ministry of Health officials while ‘defending’ their budget. The budgets are often ‘padded’ with useless projects inserted by those with the right connections. One hospital leader told me a few years ago that the monthly discretionary budget was less than N10million. This is for a hospital with nearly 1000 beds. Some families in Nigeria have a monthly budget higher than this. Little wonder, the hospital leaders seem impotent when it comes to service development.
I feel strongly that the government needs to free our hospitals from the shackles of federal bureaucracy. They should have independent boards who can then appoint leaders with the appropriate skill set and experience. The hospitals should keep the income they generate, and any profits should go to helping indigent patients. The government through National Insurance should ensure that the millions of underprivileged do not die because they could not afford care. This is a collective stain on our conscience as a nation. In my many visits to Nigerian health institutions, I have been haunted by the image of dying patients on the wards who could not afford the operation or expensive medication that could save their lives.
Your Excellency, you have a proven track record of seeking out and appointing competent professionals to key positions when you were governor of Lagos State. I noted at the time that your cabinet was better qualified than the Federal Cabinet at the time. Nigeria desperately needs its best brains. Coming from a political family, I am not ignorant of the political calculations that go into making these important decisions. Healthcare is too important to the advancement of any nation that it must not be left to the mercy of clueless appointees who are in it for themselves. My late father (May Allah rest his soul) thought highly of your ability to get things done and your tenacity and he was rarely wrong in his judgment of character. I am one of the millions of Nigerians wishing you well and praying for your success as all our futures depends on it.
Dr Ahmad writes from Dorset, United Kingdom
